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Should Europe have a universal hepatitis B vaccination programme?

BMJ 2013; 347 doi: (Published 10 July 2013) Cite this as: BMJ 2013;347:f4057
  1. Pierre Van Damme, professor1,
  2. Elke Leuridan, postdoctoral researcher 1,
  3. Greet Hendrickx, project manager1,
  4. Alex Vorsters, researcher1,
  5. Heidi Theeten, assistant professor1,
  6. Tuija Leino, senior medical officer2,
  7. Mika Salminen, research professor\3,
  8. Markku Kuusi, senior medical officer3
  1. 1Centre for the Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
  2. 2National Institute for Health and Welfare, Department of Vaccination and Immune Protection, Helsinki, Finland
  3. 3National Institute for Health and Welfare, Department of Infectious Disease Surveillance and Control, Helsinki, Finland
  1. Correspondence to: P Van Damme pierre.vandamme{at}, M Kuusi markku.kuusi{at}

WHO recommends that hepatitis B virus should be included in childhood vaccination programmes. Pierre Van Damme and colleagues argue that universal immunisation is essential to stop people becoming carriers but Tuija Leino and colleagues think that a targeted approach is a better use of resources in countries with low endemicity

Yes—Pierre Van Damme, Elke Leuridan, Greet Hendrickx, Alex Vorsters, Heidi Theeten

Hepatitis B occurs worldwide, with more than two billion people having been infected with the virus.1 Of these, about 240 million are living with chronic infection and at risk of cirrhosis and hepatocellular carcinoma, diseases that are estimated to cause 500 000-700 000 deaths a year.2 The risk of developing chronic infection decreases with age, occurring in up to 90% of infants infected during first year of life versus 5% of those infected as adults.1 Globally, newborns and infants are therefore the main target of hepatitis B immunisation programmes. In 1991 the World Health Organization set 1997 as the target for integrating hepatitis B vaccine into national immunisation programmes worldwide,3 and in 2010 the World Health Assembly adopted a resolution calling for a comprehensive prevention and control strategy, including universal hepatitis B vaccination and development of time specific immunisation goals.4 By the end of 2012, 179 countries—93% of WHO member states—had added hepatitis B vaccine to their national newborn, infant, or adolescent immunisation programmes.2 It is time that all European countries followed suit.

Infection in Europe

About 14 million people are chronically infected with hepatitis B virus (HBV) in the WHO European region (53 countries), and 36 000 die each year from HBV related causes.2 Forty seven European countries have a universal HBV immunisation programme as well as strategies for immunising high risk groups. Routine immunisation has created a generation of children and young adults with virtually no markers of HBV infection. Surveillance data from Italy, where universal infant …

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